157 



AGUE. 



AGUE. 



168 



with ague amounted to 200, not one case had occurred for several 

 years. 



/! ni">' or in-' ii;*/i'--xi,ii/ 1 '</..(. The remote, or the predisposing cause 

 of the disease is that which brings the system into a condition capable 

 of being affected by the immediate or exciting cause. Whatever 

 diminishes the vigorous action of the organs, impairs their functions 

 and so weakens the general strength of the system, is capable of be- 

 coming a predisposing cause of fever ; and every predisposing cause 

 1 1 one or other of these modes, and becomes a predisposing cause 

 only and in proportion as it lessens the energy of the system, or dis- 

 turbs the Valance of its actions, which in fact is to render some portion 

 of it weak. During a state of vigorous health the body is endowed 

 with the power of resisting the influence of noxious agents, which 

 in a less perfect state of health are capable of producing intense and 

 fatal disease ; and the action of all predisposing causes is to lessen this 

 ting power, or to weaken the energies of life. 



Of all the predisposing causes of ague the most powerful is the con- 

 '1 presence, and the slow operation of the immediate or the ex- 

 i-iting cause. The manner in which the immediate or the exciting 

 cause of fever operates as a predisposing cause has been amply illus- 

 trated by Dr. Southwood Smith. " It is a matter of constant observa- 

 tion," gays this author, " that the febrile poison may be present in 

 ,ent intensity to affect the health, without being sufficiently 

 l>ot*nt to produce fever. In this case the energy of the action of the 

 organs is diminished, their functions are languidly performed, the 

 entire system is wakened, and this increases until at length the power 

 of resistance is less than the power of the poison. Whenever this 

 us, fever is induced ; not that the power of the poison may be at 

 all increased, but the condition of the system is changed, in conse- 

 quence of which it is capable of offering less resistance to the noxious 

 agent that assails it." 



Dr. Potter gives a remarkable example of this fact, with regard to 

 t he yellow fever, which fell under his own observation, and states other 

 facts strikingly illustrative of the influence and operation of the pre- 

 in causes. Strangers, from certain countries, he informs us, 

 are insusceptible of yellow fever in America. In the most malignant 

 niotracted epidemics which afflict that country, these strangers 

 uniformly escape; emigrants from the West Indies, and other warm 

 I ititudes, for example, invariably resist the cause which produces these 

 maladies in the native inhabitants. But the curious fact is, that such 

 persons are unable permanently to resist the operation of the exciting 

 cause ; for, after a residence in America of some years, their constitu- 

 tion is so completely assimilated by the influence of the climate to that 

 of the American, that they become equally sensible to its febrile 

 miasma, and are as exquisitely impressed by them as the American 

 citizens themselves. The illustration is equally striking and instructive 

 if Hi* position be reversed. The natives of northern climates are ex- 

 tremely susceptible to the influence of these miasma; that suscepti- 

 bility is in exact proportion to the latitude of their country : those 

 from the north of Kurope scarcely ever escape an attack ; the natives 

 of Great Britain are nearly as susceptible to the influence of the poison, 

 while persons even from the more northern countries of the United 

 - are more liable to the disease than the citizens of the southern 

 and middle States." 



Among the other predisposing causes may be reckoned the period of 

 life. All persons between the age of puberty and that of thirty-eight 

 are peculiarly predisposed to this disease. After the disease has once 

 existed, there remains in the constitution a remarkable susceptibility 

 to its recurrence ; and that from very slight causes, as from the preva- 

 lence of an easterly wind, or exposure to a very minute quantity of 

 the poison that originally produced it, such as would not affect a person 

 who had never been the subject of the disease. Hence, persons who 

 have been once or twice, or oftener affected with ague, are most delicate 

 tents of the presence of the exciting poison. Deficient and poor diet ; 

 intemperance ; physical and mental fatigue ; anxiety, cold, damp, 

 il'-ljility, however induced all these are extremely powerful predis- 

 |x>xing causes. They enable a less dose of the poison to produce the 

 fever, and they increase the intensity of it when established. They all 

 act by weakening the resisting power inherent in the constitution, that 

 i, by enfeebling the powers of life. 



T>-"ii,iii ni nf A;pie. The first object in the treatment of a person 

 affected with ague is to remove him from the influence of the poison 

 by taking him out of an unhealthy, and placing him in a healthy 

 V'li. Unless this can be done, every remedy employed must act 

 at a great disadvantage, and the power of the poison, or the debility of 

 't.ient, may be such as to render every effort to cure the disease 

 riling without a change of residence. Often, however, circum- 

 stances will not admit of the removal of the patient. Whenever this 

 if the case, the sick person must at least be put and kept in an apart- 

 ment the moat remote from the noxious spot, and it is a good and 

 important general rule to place him in the highest part of the house. 

 When this precaution is neglected, remedies constantly fail which 

 readily and completely succeed when it is observed. 



The treatment of ague includes the management during the paroxysm, 

 the iiitnniiwion, and the convalescence. 



Hint, of the treatment during the pnroxysm. The approach of the 

 paroxysm should be carefully watched. The moment the first indica- 

 tion of jt accession is apparent, an emetic, consisting of twenty grains 



of the powder of ipecacuanha with one grain of the tartar emetic, 

 should be given, and as soon as the operation of the emetic is over, a 

 draught should be taken, consisting of from twenty to forty drops of 

 laudanum in an ounce and a half of camphor julep. This plan, in 

 almost all cases, will completely stop the coming on of the cold fit ; in 

 a great number of cases it will also prevent altogether the accession of 

 the hot fit, inducing at once the sweating stage, that is, the stage which 

 constitutes the solution of the paroxysm. But if it should not actually 

 stop the accession of the hot stage, it will assuredly diminish its vio- 

 lence and shorten its duration ; and as soon as the hot stage is formed, 

 the laudanum should be repeated in smaller doses, namely, in doses of 

 from ten to twelve drops, repeated every hour, and continued until the 

 sweating stage is completely established. 



As soon as the cessation of the sweating stage terminates tho 

 paroxysm, and the latter is succeeded by the stage of intermission, 

 cinchona bark should be freely taken. Of all the preparations of bark, 

 the sulphate of quinine is incomparably the best. The dose is from two 

 to four grains, and the most convenient mode of administering it is in 

 the form of pill. During the whole period of the intermission, the 

 dose of quinine should be repeated every hour, or every two hours, 

 according to the urgency of the case. If the biliary secretion be 

 unhealthy, which it almost always is, it will be useful to combine 

 with every alternate dose of the quinine, from the sixth to the half 

 of a grain of blue pill, together with two grains of the extract of 

 gentian. If the bowels be constipated, the addition to each pill of 

 from one to two grains of the extract of rhubarb will form an excellent 

 aperient. Given in this mode, the extract of rhubarb moderately, but 

 in general effectually, stimulates the alimentary canal, gently increasing 

 its action, without producing purging. If, however, the bowels be 

 constitutionally toqiid, or be rendered so by the disease, a more active 

 aperient must be substituted, and such will be found in the compound 

 decoction of aloes, or the infusion of senna with camomile. The con- 

 dition of the bowels must never be neglected, for a state of constipa- 

 tion will powerfully counteract every remedy. 



This plan should be continued without intermission until the 

 recurrence of the symptoms which denote a fresh accession of the 

 paroxysm. Then the quinine, &c. should be suspended, and the 

 emetic should be again repeated, which, as soou as its action li- 

 censed, should be followed by the opiate, and this, on the solution of 

 the paroxysm, by the bark, and so on in a constant series, until the 

 paroxysm return no more. By this method'of treatment the disease is 

 usually cured after the third accession, consequently it is seldom 

 necessary to repeat the emetic more thau three times, and often twice 

 and even once is sufficient. 



Quinine, however powerful and effectual during the intermission, is 

 commonly conceived to be useless and even pernicious during the 

 paroxysm. But this is the period when opium is most effectual. It has 

 even been given with success as the sole remedy. Dr. Trotter, who had an 

 opportunity of observing its effects on a large scale in the Channel fleet, 

 under Earl Howe, states, that whenever the sick felt the first approach 

 of an attack, he prescribed from thirty to forty drops of laudanum ; 

 that if this dose did not bring on some warmth in the course of ten or 

 fifteen minutes, he gave from twelve to fifteen drops more ; that it was 

 seldom necessary to increase the quantity beyond sixty drops in the 

 space of an hour, decided relief being always afforded in that time ; 

 that in a few minutes from the exhibition of the opiate the spirits 

 became exhilarated ; the constriction on the skin was removed, and was 

 followed by relaxation ; the countenance looked more animated ; a 

 flush spread itself over the cheek ; the pulse, from having been weak, 

 quick, irregular, and sometimes intermittent, became less frequent, and 

 more full and more equal ; an agreeable warmth was diffused over the 

 whole frame, and every unpleasant feeling vanished sometimes in a 

 quarter of an hour. As soon as any symptoms indicated a return of the 

 paroxysm, the laudanum was repeated in the same manner as at the 

 accession of a former fit, and always with equal success, so that the 

 patient seldom experienced much trembling and shaking; it was 

 observed that the second paroxysm was commonly an hour or two 

 later in the day than the preceding, and bvit few instances occurred of 

 a return of the disease after the third paroxysm. The patients them- 

 selves were so satisfied of the efficacy of this remedy, that the moment 

 they felt the first approach of an attack, they were sure to run to the 

 cock-pit for relief. Dr. Lind, who also tried this remedy on a large scale, 

 states that according to his experience, the good effects of opium arc 

 more uniform and powerful in intermittent fever than in any other 

 disease, and that it affects the disease more rapidly than any other 

 medicine ; that if taken during the intermissions it has no effect either 

 in preventing or mitigating the succeeding paroxysm; that when 

 given in the cold fit, it occasionally removed it; but that when 

 administered half an hour after the commencement of a hot fit, it 

 almost always afforded Immediate relief. 



It is not sufficient that the recurrence of the paroxysm has been 

 stopped once or twice by the use of the remedies prescribed. It 

 should be borne in mind that there is in this disease a great tendency 

 to relapse, and this tendency continues through the whole period of 

 convalescence, and for some time after. The quinine should be con- 

 tinued in smaller doses for some weeks after the last paroxysm has 

 supervened, especially if the weather be damp or easterly winds 

 prevail, 



